Everflo Test Data Sheet - Philips EverFlo Q Service And Technical Reference Manual

9.3

EVERFLO TEST DATA SHEET

All information on this data sheet should be entered in the correct location after the associated test
was completed. The data sheet must then be signed in ink and dated by the technician performing
tests. Circle "Pass" or "Fail". Leave all unused boxes blank.
Step 2
Serial Number: ___________________ VAC: __________ Hz: __________
Model Number: ___________________
Step 5
Oxygen Outlet Pressure
5.0 - 7.0 psig
Step 6
No Flow Alarms < 120 sec.
EverFlo T Devices < 160 sec.
Step 7
Flow Meter Oxygen
Concentration
(Pediatric Flow Settings)
Step 8
OPI Verification
Signature: _____________________
Print Name __________________________Asset Numbers____________________/ ____________________
Page 93
NOTE
Step 3
Pass Fail
EverFlo Models
90-96% @ 2 LPM
90-96% @ 5 LPM
2 LPM 5 LPM
(0.1LPM) (1LPM)
Pass Fail
Date: _____________ Notification Number: ______________________
LO TM
E F S & T
VER ERVICE
Pediatric Flow Meter
1020007 and 1020008
87-96% @ 2 LPM
87-96% @ 5 LPM
2 LPM
(0.1LPM)
Step 13
O2 Coupler Flow > 10 SLPM
(PRI internal use Only)
I
ECHNICAL NFORMATION
Step 4
Hour Meter: ______________
Yes No
5 LPM
(1LPM)
Pass Fail
(PRI internal use Only)
1039055, VER. 06